中文摘要：

目的探讨剖宫产后阴道分娩的可行性及安全性。方法回顾性分析140例剖宫产后足月阴道试产（VBAC组）的资料,105例成功,35例失败转急诊剖宫产（转剖宫产组）,并抽取同期110例选择性重复剖宫产为对照组。比较母儿的一般情况及妊娠结局。结果 VBAC组阴道分娩史42例（40%）、子宫下段全层的厚度（3.20±0.28）mm、宫颈成熟105例（100%）均高于对照组（P〈0.05）,两组的新生儿窒息、新生儿黄疸、脏器损伤、产褥病率的差异均无统计学意义（P〉0.05）,产时出血量（175.48±65.51）m L、新生儿体重（2.87±1.21）kg、子宫收缩乏力3例（2.9%）、输血2例（1.9%）、切口愈合不良1例（0.95%）VBAC组均低于对照组（P〈0.05）。转剖宫产组与对照组的手术时间及母儿并发症的差异均无统计学意义（P〉0.05）。结论阴道分娩史、子宫下段全层厚度、宫颈成熟及新生儿体重均与剖宫产后阴道分娩成功率密切相关。剖宫产后阴道分娩有效降低产时出血量、子宫收缩乏力、输血率及切口愈合不良,试产失败转急诊剖宫产未增加母儿并发症。

英文摘要：

Objective To assess the feasibility and safety of vaginal birth after cesarean delivery. Methods A retrospective study was conducted,which included 140 cases with trial of labor after cesarean delivery as the study group. 105 cases were successful,35 cases failed. The 110 cases of elective repeat cesarean delivery in the same period were included as the control group. Maternal and fetal general information and perinatal outcomes were analyzed. Results In the study group,forty- two cases had a history of vaginal delivery. The whole thickness of lower uterine segment was（ 3. 2 ± 0. 28）mm. All patients had a mature cervix. These parameters were all higher than in the control group（ P 0. 05）. There were no statistically significant differences in neonatal asphyxia,neonatal jaundice,visceral injury and puerpera morbidity between the two groups（ P 0. 05）. In the study group,the intrapartum hemorrhage was（ 175. 48 ± 65. 51） m L. The birth weight was（ 2. 87 ± 1. 21） kg. Three patients had weakness of uterine contraction. Blood transfusion occurred in two patients. Poor healing of the incision occurred in one patient. These parameters were lower than those in the control group（ P 0. 05）. There were no significant differences in duration of surgery,maternal and fetal complications between the emergency repeat cesarean delivery after failed vaginal birth group and the control group（ P 0. 05）. Conclusions History of vaginal delivery,whole thickness of lower uterine segment,cervical maturity and birth weight are closely related to the success rate of vaginal birth after cesarean delivery. Vaginal birth after cesarean delivery can effectively reduce intrapartum hemorrhage,weakness of uterine contraction,blood transfusion and poor healing of uterine incision. Emergency repeat cesarean delivery after failed vaginal birth does not increase duration of surgery or maternal and fetal complications.